title: Pulmonary arterial hypertension: basis of sex differences in incidence and treatment response.
abstract: Pulmonary arterial hypertension (PAH) is a complex disease characterized by elevated pulmonary arterial pressure, pulmonary vascular remodelling and occlusive pulmonary vascular lesions, leading to right heart failure. Evidence from recent epidemiological studies suggests the influence of gender on the development of PAH with an approximate female to male ratio of 4:1, depending on the underlying disease pathology. Overall, the therapeutic strategy for PAH remains suboptimal with poor survival rates observed in both genders. Endogenous sex hormones, in particular 17β oestradiol and its metabolites, have been implicated in the development of the disease; however, the influence of sex hormones on the underlying pathobiology remains controversial. Further understanding of the influence of sex hormones on the normal and diseased pulmonary circulation will be critical to our understanding the pathology of PAH and future therapeutic strategies. In this review, we will discuss the influence of sex hormones on the development of PAH and address recent controversies.
authors.affiliation: Institute of Cardiovascular and Medical Sciences, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
authors.forename: K M
authors.initials: KM
authors.lastname: Mair
authors.forename: A K Z
authors.initials: AK
authors.lastname: Johansen
authors.forename: A F
authors.initials: AF
authors.lastname: Wright
authors.forename: E
authors.initials: E
authors.lastname: Wallace
authors.forename: M R
authors.initials: MR
authors.lastname: MacLean
mesh_terms: D000728:Androgens / Q000378:metabolism; D000818:Animals; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004198:Disease Susceptibility; D004351:Drug Resistance; D004967:Estrogens / Q000378:metabolism; D019317:Evidence-Based Medicine; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy; D015994:Incidence; D008168:Lung / Q000098:blood supply / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D008954:Models, Biological; D011652:Pulmonary Circulation / Q000187:drug effects*; D011960:Receptors, Estrogen / Q000378:metabolism; D012727:Sex Characteristics; D014655:Vascular Resistance / Q000187:drug effects
chemical_list: D000728:Androgens; D002317:Cardiovascular Agents; D004967:Estrogens; D011960:Receptors, Estrogen
keywords: oestrogen; pulmonary arterial hypertension; serotonin; sex hormones; testosterone; vascular remodelling